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4\ D.9"' Application for a Per it to Build\46No. �3
1'2 Fee must accompany his application
Yarmouth1.1 .[...19... .
TO THE BOARD OF SELECTMEN 72/6
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The undersigned hereby applies for a permit to build, according to the following specifications: f
1. Name of Owner �'dw.a�J Address /1 /17,pr�,&Jt w j9%t
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2. Name of Architect (if any) W'I/�[/11QJ /n0..
3. Name of Builder r• (. //dgyl,Q
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4. Precinct No. RI Lot No.. .// Plan: Name or No. 3 3 c/3
5. Name of Street/1 /1y]� 61-p-7, (49
6. Purpose of Building / 61Aa
7. Material We DJ. FrWnc (` i C IA
8. . Estimated cost of building / QC)O • GARAGE 4 OPEN
9. Dwelling / Q,a,t,,pt t..e DREfiZEWAy—cix,a
10. Cottage �[.ccatsal�
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11. Heat . _
12. Basement
13. Garage
14. Store +.--•
15. Shop
16. No. of stories /
17. Is there to be a Store in the lower storey /V
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18.
18. Size of Lot. No. 'of feet front/ ... I a{
I No. of feet rear aS /03 No. of feet deep ./D°
19. Size of building. No. of feet front /eo No. of feetside ...-a& �N)o.. ofoffeet rear le
20. Distance from nearest building: Front "C-49. ft.; side.... ?.0 ' ft.; side ,449 ft.; rear llf
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21. Distance back from line or street 5"? , from rear lot line Pe)i , side line --/°, f
Show by diagram the location of propsed building with relation to distances from adjoining lots,
,00nnreverse side.
Name 744 "Wftf.'OfYrel'`
Address.... 5 weyd/t41dsbdted- //jeu A.cr -
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Street Name
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r - LeftSide Depth of Lot / Ov
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rA143
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Right Side Depth of Lot ..../ 0.c7 '
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Street Name d z - .
BUILDING PERMIT REVIEW
PPLICANT': ;. . a, . / a• f • r(c es. i,. . • t BLDG PERMIT NO: .
LOCATIJN OF P'•PERTY: /1 ,¢.c ,J t.061y //1.0_ C/ ovjt(• DATE FILED: •
•
HE FOLLOWING CHECK-OFF SHEEP IS DESIGNED TO CLARIFY THE PROCEDURE AN INDIVILUAL MUST .
FOLLOW IN ORDER TO OBTAIN A PERMIT TO BUILD OR ALTER A BUILDING. THE BUILDING DEPARTMENT
nTLL CHECK ONTHE FOLLOWING: (A) CONSERVANCY DISTRICTS (B) HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING:THE APPLICANT THROUGH THE FOLLOWING
4GENCIES. j
.ESIDENTIAL BUILDING: •
t) CHECK WITH THE HEALTH DEPARTMENT IN REFER CE TO SEPTIC SYSTEMS FOR SEWAGE DISPOSAL.
) CHECK WITH CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYPE OF WETLANDS.
EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS, MARSH, ETC.
) CHECK WITH PLANNING BOARD FOR LOT RELEASE.
)PMERCIAL BUILDING:
) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE PLAN .
REVIEW.
) CONSERVATION C4ITTEE-IF LOT BORDERS ANY TYPE) OF WETLANDS.
) PLANNING BOARD- TO SEE IF IAT COMPLIES WITH ZONING BY-LAtS.
) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC.
) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFRII, (SPRINKLERS, SMOKE
DETECTORS).
-
rVIE ni BY:
GI/
NEERRING DEPARTMENT: YES DOES NOT APPLY SIGNATURE atilt DATE 7'31/80
N'IWATION CGhALITTEE: YES_DOrS_NOT APPLY V/SIGNATURE. , i,. DATE '(,31,80
/ SRD: YES DOES NOT APPLY SIGNATURE DATE
'ARtD OF HEALTH: YES ciT50FS NOT APPLY_SIGNATURE -• DATE 77
IREJT: YES DOES NOT APPLY SIGNATURE DATE
OMMENTS: t